Method and apparatus for treating a hip joint, including the provision and use of a novel suture passer

ABSTRACT

A suture passer includes a shaft having an axis, a first jaw mounted to the shaft in alignment with the axis, the first jaw being configured to releasably support a length of suture thereon; a second jaw movably mounted to the shaft, and a needle movably mounted to the shaft, the needle having a hook and being configured to reciprocate in alignment with the axis so that the hook can selectively pass by the second jaw and engage suture releasably supported on the first jaw, wherein the first jaw comprises a spring for selectively binding the suture to the first jaw, and further wherein the spring comprises a recess for receiving the suture therein.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.16/515,407, filed Jul. 18, 2019, which is a continuation of U.S. patentapplication Ser. No. 14/955,451, filed Dec. 1, 2015, now U.S. Pat. No.10,357,243, which is a continuation of U.S. patent application Ser. No.13/564,087, filed Aug. 1, 2012, now U.S. Pat. No. 9,198,655, whichclaims the benefit of U.S. Provisional Application No. 61/513,869, filedAug. 1, 2011, and is a continuation-in-part of U.S. patent applicationSer. No. 12/831,937, filed Jul. 7, 2010, now U.S. Pat. No. 8,469,974,which claims the benefit of U.S. Provisional Application No. 61/270,985,filed Jul. 15, 2009, and U.S. Provisional Application No. 61/327,431,filed Apr. 23, 2010, the entire contents of each of which are herebyincorporated by reference herein.

FIELD OF THE INVENTION

This invention relates to surgical methods and apparatus in general, andmore particularly to surgical methods and apparatus for treating a hipjoint.

BACKGROUND OF THE INVENTION The Hip Joint in General

The hip joint is a ball-and-socket joint which movably connects the legto the torso. The hip joint is capable of a wide range of differentmotions, e.g., flexion and extension, abduction and adduction, medialand lateral rotation, etc. See FIGS. 1A, 1B, 1C and 1D.

With the possible exception of the shoulder joint, the hip joint isperhaps the most mobile joint in the body. Significantly, and unlike theshoulder joint, the hip joint carries substantial weight loads duringmost of the day, in both static (e.g., standing and sitting) and dynamic(e.g., walking and running) conditions.

The hip joint is susceptible to a number of different pathologies. Thesepathologies can have both congenital and injury-related origins. In somecases, the pathology can be substantial at the outset. In other cases,the pathology may be minor at the outset but, if left untreated, mayworsen over time. More particularly, in many cases, an existingpathology may be exacerbated by the dynamic nature of the hip joint andthe substantial weight loads imposed on the hip joint.

The pathology may, either initially or thereafter, significantlyinterfere with patient comfort and lifestyle. In some cases, thepathology can be so severe as to require partial or total hipreplacement. A number of procedures have been developed for treating hippathologies short of partial or total hip replacement, but theseprocedures are generally limited in scope due to the significantdifficulties associated with treating the hip joint.

A better understanding of various hip joint pathologies, and also thecurrent limitations associated with their treatment, can be gained froma more thorough understanding of the anatomy of the hip joint.

Anatomy of the Hip Joint

The hip joint is formed at the junction of the leg and the torso. Moreparticularly, and looking now at FIG. 2 , the head of the femur isreceived in the acetabular cup of the hip, with a plurality of ligamentsand other soft tissue serving to hold the bones in articulatingcondition.

More particularly, and looking now at FIG. 3 , the femur is generallycharacterized by an elongated body terminating, at its top end, in anangled neck which supports a hemispherical head (also sometimes referredto as “the ball”). As seen in FIGS. 3 and 4 , a large projection knownas the greater trochanter protrudes laterally and posteriorly from theelongated body adjacent to the neck of the femur. A second, somewhatsmaller projection known as the lesser trochanter protrudes medially andposteriorly from the elongated body adjacent to the neck. Anintertrochanteric crest (FIGS. 3 and 4 ) extends along the periphery ofthe femur, between the greater trochanter and the lesser trochanter.

Looking next at FIG. 5 , the hip socket is made up of three constituentbones: the ilium, the ischium and the pubis. These three bones cooperatewith one another (they typically ossify into a single “hip bone”structure by the age of 25 or so) in order to collectively form theacetabular cup. The acetabular cup receives the head of the femur.

Both the head of the femur and the acetabular cup are covered with alayer of articular cartilage which protects the underlying bone andfacilitates motion. See FIG. 6 .

Various ligaments and soft tissue serve to hold the ball of the femur inplace within the acetabular cup. More particularly, and looking now atFIGS. 7 and 8 , the ligamentum teres extends between the ball of thefemur and the base of the acetabular cup. As seen in FIGS. 8 and 9 , alabrum is disposed about the perimeter of the acetabular cup. The labrumserves to increase the depth of the acetabular cup and effectivelyestablishes a suction seal between the ball of the femur and the rim ofthe acetabular cup, thereby helping to hold the head of the femur in theacetabular cup. In addition to the foregoing, and looking now at FIG. 10, a fibrous capsule extends between the neck of the femur and the rim ofthe acetabular cup, effectively sealing off the ball-and-socket membersof the hip joint from the remainder of the body. The foregoingstructures (i.e., the ligamentum teres, the labrum and the fibrouscapsule) are encompassed and reinforced by a set of three main ligaments(i.e., the iliofemoral ligament, the ischiofemoral ligament and thepubofemoral ligament) which extend between the femur and the perimeterof the hip socket. See, for example, FIGS. 11 and 12 , which show theiliofemoral ligament, with FIG. 11 being an anterior view and FIG. 12being a posterior view.

Pathologies of the Hip Joint

As noted above, the hip joint is susceptible to a number of differentpathologies. These pathologies can have both congenital andinjury-related origins.

By way of example but not limitation, one important type of congenitalpathology of the hip joint involves impingement between the neck of thefemur and the rim of the acetabular cup. In some cases, and looking nowat FIG. 13 , this impingement can occur due to irregularities in thegeometry of the femur. This type of impingement is sometimes referred toas cam-type femoroacetabular impingement (i.e., cam-type FAI). In othercases, and looking now at FIG. 14 , the impingement can occur due toirregularities in the geometry of the acetabular cup. This latter typeof impingement is sometimes referred to as pincer-type femoroacetabularimpingement (i.e., pincer-type FAI). Impingement can result in a reducedrange of motion, substantial pain and, in some cases, significantdeterioration of the hip joint.

By way of further example but not limitation, another important type ofcongenital pathology of the hip joint involves defects in the articularsurface of the ball and/or the articular surface of the acetabular cup.Defects of this type sometimes start out fairly small but often increasein size over time, generally due to the dynamic nature of the hip jointand also due to the weight-bearing nature of the hip joint. Articulardefects can result in substantial pain, induce and/or exacerbatearthritic conditions and, in some cases, cause significant deteriorationof the hip joint.

By way of further example but not limitation, one important type ofinjury-related pathology of the hip joint involves trauma to the labrum.More particularly, in many cases, an accident or sports-related injurycan result in the labrum being torn away from the rim of the acetabularcup, typically with a tear running through the body of the labrum. SeeFIG. 15 . These types of injuries can be very painful for the patientand, if left untreated, can lead to substantial deterioration of the hipjoint.

The General Trend Toward Treating Joint Pathologies UsingMinimally-Invasive, and Earlier, Interventions

The current trend in orthopedic surgery is to treat joint pathologiesusing minimally-invasive techniques. Such minimally-invasive, “keyhole”surgeries generally offer numerous advantages over traditional, “open”surgeries, including reduced trauma to tissue, less pain for thepatient, faster recuperation times, etc.

By way of example but not limitation, it is common to re-attachligaments in the shoulder joint using minimally-invasive, “keyhole”techniques which do not require large incisions into the interior of theshoulder joint. By way of further example but not limitation, it iscommon to repair torn meniscal cartilage in the knee joint, and/or toreplace ruptured ACL ligaments in the knee joint, usingminimally-invasive techniques.

While such minimally-invasive approaches can require additional trainingon the part of the surgeon, such procedures generally offer substantialadvantages for the patient and have now become the standard of care formany shoulder joint and knee joint pathologies.

In addition to the foregoing, in view of the inherent advantages andwidespread availability of minimally-invasive approaches for treatingpathologies of the shoulder joint and knee joint, the current trend isto provide such treatment much earlier in the lifecycle of thepathology, so as to address patient pain as soon as possible and so asto minimize any exacerbation of the pathology itself. This is in markedcontrast to traditional surgical practices, which have generallydictated postponing surgical procedures as long as possible so as tospare the patient from the substantial trauma generally associated withinvasive surgery.

Treatment for Pathologies of the Hip Joint

Unfortunately, minimally-invasive treatments for pathologies of the hipjoint have lagged far behind minimally-invasive treatments forpathologies of the shoulder joint and the knee joint. This is generallydue to (i) the constrained geometry of the hip joint itself, and (ii)the nature and location of the pathologies which must typically beaddressed in the hip joint.

More particularly, the hip joint is generally considered to be a “tight”joint, in the sense that there is relatively little room to maneuverwithin the confines of the joint itself. This is in marked contrast tothe shoulder joint and the knee joint, which are generally considered tobe relatively “spacious” joints (at least when compared to the hipjoint). As a result, it is relatively difficult for surgeons to performminimally-invasive procedures on the hip joint.

Furthermore, the pathways for entering the interior of the hip joint(i.e., the natural pathways which exist between adjacent bones and/ordelicate neurovascular structures) are generally much more constrainingfor the hip joint than for the shoulder joint or the knee joint. Thislimited access further complicates effectively performingminimally-invasive procedures on the hip joint.

In addition to the foregoing, the nature and location of the pathologiesof the hip joint also complicate performing minimally-invasiveprocedures on the hip joint. By way of example but not limitation,consider a typical detachment of the labrum in the hip joint. In thissituation, instruments must generally be introduced into the joint spaceusing an angle of approach which is offset from the angle at which theinstrument addresses the tissue. This makes drilling into bone, forexample, significantly more complicated than where the angle of approachis effectively aligned with the angle at which the instrument addressesthe tissue, such as is frequently the case in the shoulder joint.Furthermore, the working space within the hip joint is typicallyextremely limited, further complicating repairs where the angle ofapproach is not aligned with the angle at which the instrument addressesthe tissue.

As a result of the foregoing, minimally-invasive hip joint proceduresare still relatively difficult to perform and relatively uncommon inpractice. Consequently, patients are typically forced to manage theirhip pain for as long as possible, until a resurfacing procedure or apartial or total hip replacement procedure can no longer be avoided.These procedures are generally then performed as a highly-invasive, openprocedure, with all of the disadvantages associated withhighly-invasive, open procedures.

As a result, there is, in general, a pressing need for improved methodsand apparatus for treating pathologies of the hip joint.

The Fibrous Capsule

As noted above, a fibrous capsule extends between the neck of the femurand the rim of the acetabular cup, effectively sealing off theball-and-socket elements of the hip joint from the remainder of thebody.

While the fibrous capsule provides an important function inencapsulating the hip joint, it also presents a significant obstacle toarthroscopically treating pathologies of the hip joint. Moreparticularly, the fibrous capsule presents a tough physical barrierwhich must be penetrated in order to arthroscopically access theinterior of the hip joint. However, the penetration of this toughphysical barrier must be effected very carefully, since the anatomicalstructures which are located immediately below the fibrous capsule arefrequently delicate and sensitive to damage.

In addition to the foregoing, the fibrous capsule generally sits inclose proximity to the underlying bone. As a result, the workspacelocated between the fibrous capsule and the underlying bone is typicallyquite limited, thereby presenting significant visualization andoperational challenges to the surgeon.

By way of example but not limitation, arthroscopic treatment of cam-typefemoroacetabular impingement (i.e., cam-type FAI) is significantlycomplicated by the limited workspace present within the fibrous capsule.More particularly, cam-type FAI is generally caused by irregularovergrowths in the geometry of the femur. Treatment of cam-type FAIgenerally calls for debridement of these femoral overgrowths using aburr or other debridement tool. However, the lack of workspace betweenthe overlying fibrous capsule and the underlying femur can make suchdebridement procedures technically challenging for even the mostexperienced surgeons, because it can severely limit the field of visionwithin the workspace and inhibit proper positioning of the burr.

As a result, there is a pressing need for an improved method andapparatus for increasing the workspace around the femur during anarthroscopic hip procedure.

Capsule Release and Subsequent Re-Stitching

It has been recognized that the workspace around the top end of thefemur can be significantly increased during an arthroscopic procedure ifthe fibrous capsule can be laid open at the start of the arthroscopicprocedure and then, at the conclusion of the procedure, the fibrouscapsule restored, e.g., by suturing.

More particularly, it has been recognized that an arthroscopic procedurecan be performed on the hip joint by (i) creating one or more accessportals from the surface of the skin down to the fibrous capsule; (ii)opening the fibrous capsule so as to expose the underlying joint; (iii)performing the desired therapeutic procedure on the underlying joint(e.g., debridement of a femoral overgrowth so as to treat a cam-typeFAI); and (iv) restoring the fibrous capsule at the conclusion of theprocedure by suturing closed the laid-open capsule.

However, heretofore, it has been technically challenging toarthroscopically suture closed the laid-open fibrous capsule at theconclusion of the therapeutic procedure. This is largely because (i) theworkspace present at the remote surgical site is quite limited, and (ii)the fibrous capsule is made up of unusually tough tissue, which can makeit extremely difficult to arthroscopically pass suture through thefibrous capsule in the suturing operation.

Thus there is a need for a new method and apparatus for passing suturethrough the fibrous capsule in a suturing operation, thereby making itmore practical for a surgeon to arthroscopically operate on the hipjoint by first laying open the fibrous capsule, performing the desiredprocedure on the hip joint, and then closing the fibrous capsule bysuturing at the conclusion of the procedure.

SUMMARY OF THE INVENTION

The present invention provides a novel method and apparatus for passingsuture through the fibrous capsule in a suturing operation, therebymaking it more practical for a surgeon to arthroscopically operate onthe hip joint by first laying open the fibrous capsule, performing thedesired procedure on the hip joint, and then closing the fibrous capsuleby suturing at the conclusion of the procedure.

In one form of the invention, there is provided a suture passercomprising:

a shaft having an axis;

a first jaw mounted to the shaft in alignment with the axis, the firstjaw being configured to releasably support a length of suture thereon;

a second jaw movably mounted to the shaft; and

a needle movably mounted to the shaft, the needle having a hook andbeing configured to reciprocate in alignment with the axis so that thehook can selectively pass by the second jaw and engage suture releasablysupported on the first jaw;

wherein the first jaw comprises a spring for selectively binding thesuture to the first jaw, and further wherein the spring comprises arecess for receiving the suture therein.

In another form of the invention, there is provided a suture passercomprising:

a shaft having an axis;

a first jaw mounted to the shaft in alignment with the axis, the firstjaw being configured to releasably support a length of suture thereon;

a second jaw movably mounted to the shaft; and

a needle movably mounted to the shaft, the needle having a hook andbeing configured to reciprocate in alignment with the axis so that thehook can selectively pass by the second jaw and engage suture releasablysupported on the first jaw;

wherein at least one of the first jaw and the shaft comprises vacuummeans for drawing tissue into the space between the first jaw and thesecond jaw.

In another form of the invention, there is provided a suture passercomprising:

a shaft having an axis;

a first jaw mounted to the shaft in alignment with the axis, the firstjaw being configured to releasably support first and second lengths ofsuture thereon;

a second jaw movably mounted to the shaft; and

a needle movably mounted to the shaft, the needle having a hook andbeing configured to reciprocate in alignment with the axis so that thehook can selectively pass by the second jaw and engage a suture lengthreleasably supported on the first jaw.

In another form of the invention, there is provided a needle assemblyfor use in a suture passer, the needle assembly comprising an innerneedle having a hook thereon, and an outer needle concentricallydisposed about the inner needle, the inner needle being spring mountedto the outer needle, wherein the needle assembly further comprises a tabmounted to the proximal end of the needle, the tab having crush ribsformed thereon.

In another form of the invention, there is provided a method for passingsuture through tissue, the method comprising:

releasably supporting a length of suture on a first jaw by binding thesuture to the first jaw with a spring, wherein the spring comprises arecess for receiving the suture therein;

advancing a second jaw toward the first jaw so as to releasably clamptissue therebetween;

advancing a needle through the tissue so that a hook on the needleengages the suture releasably supported on the first jaw; and

retracting the needle back through the tissue, with the needle carryingthe suture therewith.

In another form of the invention, there is provided a method for passingsuture through tissue, the method comprising:

providing a suture passer, the suture passer comprising:

-   -   a shaft having an axis;    -   a first jaw mounted to the shaft in alignment with the axis, the        first jaw being configured to releasably support a length of        suture thereon;    -   a second jaw movably mounted to the shaft; and    -   a needle movably mounted to the shaft, the needle having a hook        and being configured to reciprocate in alignment with the axis        so that the hook can selectively pass by the second jaw and        engage suture releasably supported on the first jaw;    -   wherein at least one of the first jaw and the shaft comprises        vacuum means for drawing tissue into the space between the first        jaw and the second jaw;

applying suction to the vacuum means, and moving the suture passeradjacent to the tissue which is to have the suture passed therethrough,such that the tissue to be sutured is disposed between the first jaw andthe second jaw;

clamping the tissue between the first jaw and the second jaw; and

passing the suture through the tissue with the needle.

In another form of the invention, there is provided a method for passingsuture through tissue, the method comprising:

providing a suture passer comprising:

-   -   a shaft having an axis;    -   a first jaw mounted to the shaft in alignment with the axis, the        first jaw releasably supporting first and second lengths of        suture thereon;    -   a second jaw movably mounted to the shaft; and    -   a needle movably mounted to the shaft, the needle having a hook        and being configured to reciprocate in alignment with the axis        so that the hook can selectively pass by the second jaw and        engage a suture length releasably supported on the first jaw;

positioning the suture passer adjacent tissue;

using the needle to pass the first length of suture through tissue;

moving the suture passer relative to the tissue; and

using the needle to pass the second length of suture through the tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIGS. 1A-1D are schematic views showing various aspects of hip motion;

FIG. 2 is a schematic view showing bone structures in the region of thehip joint;

FIG. 3 is a schematic anterior view of the femur;

FIG. 4 is a schematic posterior view of the top end of the femur;

FIG. 5 is a schematic view of the pelvis;

FIGS. 6-12 are schematic views showing bone and soft tissue structuresin the region of the hip joint;

FIG. 13 is a schematic view showing cam-type femoroacetabularimpingement (i.e., cam-type FAI);

FIG. 14 is a schematic view showing pincer-type femoroacetabularimpingement (i.e., pincer-type FAI);

FIG. 15 is a schematic view showing a labral tear;

FIGS. 16 and 17 are schematic views showing a novel suture passer formedin accordance with the present invention;

FIGS. 18-38 are schematic views showing various details of theconstruction and operation of the distal end of the novel suture passerof FIGS. 16 and 17 ;

FIGS. 39 and 40 are schematic views showing how the novel suture passerof FIGS. 16 and 17 can comprise a reusable tool assembly and adisposable needle assembly;

FIGS. 41-46, 46A and 47-50 are schematic views showing various detailsof the construction and operation of the reusable tool assembly and adisposable needle assembly of FIGS. 39 and 40 ;

FIGS. 50A, 50B and 50C are schematic views showing an alternative formof the distal jaw spring of the novel suture passer of FIGS. 16 and 17 ;

FIGS. 50D, 50E and 50F are schematic views showing another alternativeform of the distal jaw spring of the novel suture passer of FIGS. 16 and17 ;

FIGS. 50G and 50H are schematic views showing another form of the novelsuture passer of the present invention;

FIGS. 51 and 52 are schematic views showing an alternative form of theouter needle of the novel suture passer of the present invention;

FIGS. 53 and 54 are schematic views showing an alternative form of theinner needle of the novel suture passer of the present invention;

FIGS. 55-68 are schematic views showing various details of theconstruction and operation of the distal end of an alternative form ofthe novel suture passer of the present invention;

FIGS. 68A-68N are schematic views showing another form of the novelsuture passer of the present invention;

FIGS. 69-84 are schematic views showing various details of theconstruction and operation of the distal end of another alternative formof the novel suture passer of the present invention;

FIGS. 85-89 are schematic views showing an alternative form of thedistal jaw spring of the novel suture passer of FIGS. 69-84 ;

FIG. 90 is a schematic view showing another alternative construction forthe novel suture passer of the present invention;

FIGS. 90A, 90B and 90C are schematic views showing an alternative formof the novel suture passer of the present invention;

FIGS. 90D, 90E, 90F, 90G, 90H and 901 are schematic views showing thenovel suture passer of FIGS. 90A, 90B and 90C being used to pass suture;FIGS. 91-94 are schematic views showing still another alternativeconstruction for the novel suture passer of the present invention;

FIG. 95 is a schematic view showing another form of the novel suturepasser of the present invention;

FIGS. 96 and 97 are schematic views showing another alternativeconstruction for the novel suture passer of the present invention;

FIGS. 98-101 are schematic views showing another alternativeconstruction for the novel suture passer of the present invention;

FIGS. 102-110 are schematic views showing a suture passing operationbeing effected using the novel suture passer of FIGS. 98-101 ; and

FIGS. 111-119 are schematic views showing another suture passingoperation being effected using the novel suture passer of FIGS. 98-101 .

DETAILED DESCRIPTION OF THE INVENTION

Looking first at FIGS. 16 and 17 , there is shown a novel suture passer5 formed in accordance with the present invention. Suture passer 5generally comprises an elongated shaft 10 having a distal jaw 15disposed at the distal end of elongated shaft 10 and a handle 20disposed at the proximal end of elongated shaft 10.

Looking next at FIGS. 18-25 , distal jaw 15 is intended to releasablycarry a suture 25 thereon. To this end, and as will hereinafter bediscussed in further detail, distal jaw 15 has a suture slot 30 (FIG. 18) formed therein. In one preferred form of the present invention, sutureslot 30 is sized so that suture 25 can slide easily therein. And in onepreferred form of the present invention, suture slot 30 comprises aproximal longitudinal section 35, an intermediate diagonal section 40,and a distal longitudinal section 45. Distal jaw 15 also includes a slot50 (FIG. 20 ) at its distal end. A distal jaw spring 55 (FIG. 19 ) ismovably mounted in slot 50. More particularly, distal jaw spring 55 ismounted to elongated shaft 10 at the proximal end of the distal jawspring, e.g., via a pair of pins 60 extending through the proximal endof the distal jaw spring, such that the distal end of distal jaw spring55 can flex downwardly relative to distal jaw 15, in a cantileverfashion. A suture seat 70 (FIG. 25 ) is disposed at the free end ofdistal jaw spring 55. Suture seat 70 preferably has an inclined surface72 thereon to act as a ramp to aid the inner needle 80 (and/or the outerneedle 85) (see below) in displacing the distal jaw spring 55 downwardduring the inner and outer needles' deployment stroke, as willhereinafter be discussed in further detail. Distal jaw spring 55 andsuture seat 70 are sized and positioned relative to distal jaw 15 sothat suture seat 70 normally protrudes across suture slot 30 under theinfluence of distal jaw spring 55. However, suture seat 70 can be forcedout of suture slot 30 by overcoming the bias of distal jaw spring 55,e.g., by camming, as will hereinafter be discussed. As a result of thisconstruction, a suture 25 disposed in suture slot 30 can be releasablyheld in the suture slot 30 (and hence releasably held to distal jaw 15)with a light friction fit by distal jaw spring 55 and suture seat 70.

Still looking now at FIGS. 18-25 , suture passer 5 also comprises threeelements which are movable relative to elongated shaft 10 and distal jaw15, i.e., a proximal jaw 75, an inner needle 80 and an outer needle 85,with outer needle 85 being disposed co-axial with, and intermediate,inner needle 80 and proximal jaw 75. More particularly, proximal jaw 75includes a lumen 90 for slidably receiving outer needle 85 and innerneedle 80 (FIG. 19 ). Outer needle 85 comprises a lumen 95 for slidablyreceiving inner needle 80, and includes a beveled tip 100 (FIG. 21 )which closely surrounds inner needle 80 (FIGS. 21-23 ). Inner needle 80preferably comprises a sharp distal tip 105, an inclined surface 107 anda suture slot 110. Inclined surface 107 is preferably oriented towardsthe distal jaw spring 55 to facilitate displacing the distal jaw spring55 as the distal jaw spring is contacted by the inner needle 80 when theinner needle advances. In other words, inclined surface 107 of innerneedle 80 is oriented so that when the advancing inner needle 80 engagesdistal jaw spring 55, inclined surface 107 cams distal jaw spring 55downward, out of the way of the advancing inner needle 80. Suture slot110 is preferably in the form of a “crochet hook”, in the sense that itincludes a return 115 extending alongside a portion of the suture slot,whereby to provide a “crochet hook” effect for the distal end of innerneedle 80.

Returning now to FIGS. 16 and 17 , handle 20 preferably includes a grip120 for seating in the palm of the user's hand, and a trigger 125 foractuation by the user's fingers. Handle 20 is constructed so that, bypulling trigger 125 towards grip 120, and thereafter releasing trigger125, proximal jaw 75, inner needle 80 and outer needle 85 can be movedin a sequenced manner relative to elongated shaft 10 and distal jaw 15,and in a sequenced manner relative to one another, whereby to passsuture through tissue, as will hereinafter be discussed in furtherdetail. Significantly, due to the construction employed by suture passer5, suture can be arthroscopically passed through even the tough fibrouscapsule of the hip joint, whereby to permit arthroscopic suturing of thefibrous capsule. As a result, the present invention makes it morepractical for a surgeon to arthroscopically operate on the hip joint byfirst laying open the fibrous capsule, performing the desired procedureon the hip joint, and then closing the fibrous capsule by suturing atthe conclusion of the procedure.

Suture passer 5 is preferably used as follows.

Looking now at FIGS. 18 and 19 , proximal jaw 75 is initially retractedproximally relative to distal jaw 15 so as to provide a gap 127therebetween, inner needle 80 is initially retracted so that its distalend resides within lumen 90 of proximal jaw 75, and outer needle 85 isinitially retracted so that its distal end resides proximal to thedistal end of inner needle 80. A suture 25 is slipped into suture slot30 of distal jaw 15 and then pulled distally so that the suture sits atthe convergence of proximal longitudinal section 35 and intermediatediagonal section 40 of suture slot 30—this action causes the suture toengage the inclined surface 72 of suture seat 70 (FIG. 25 ) and therebydrive (i.e., cam) suture seat 70 (and the free end of distal jaw spring55) downwardly far enough for the suture to slip above suture seat 70,whereupon suture seat 70 (and distal jaw spring 55) press upwardly so asto releasably capture suture 25 in suture slot 30 via the spring-biasedsuture seat 70.

With suture passer 5 in this condition, the distal end of the suturepasser is ready to be advanced to the remote site where tissue is to besutured. By way of example but not limitation, the distal end of suturepasser 5 may be arthroscopically advanced to a laid-open fibrous capsulein the hip joint, in order to suture closed the laid-open fibrouscapsule at the conclusion of an arthroscopic procedure. Once the distalend of suture passer 5 is disposed at the remote site, the suture passeris maneuvered so that the tissue which is to be sutured is located inthe gap 127 (FIG. 18 ) between distal jaw 15 and proximal jaw 75.Alternatively, and/or additionally, the tissue which is to be suturedmay be maneuvered (e.g., with a supplemental tool) so that the tissue islocated in the gap 127 between distal jaw 15 and proximal jaw 75.

Looking next at FIGS. 26 and 27 , proximal jaw 75 is then advancedlongitudinally towards distal jaw 15 so as to securely clamp the tissuewhich is to be sutured between the two jaw members. Preferably innerneedle 80 and outer needle 85 are advanced in conjunction with proximaljaw 75, in the manner shown in FIG. 27 .

Once the tissue has been securely clamped between distal jaw 15 andproximal jaw 75, inner needle 80 and outer needle 85 are advancedtogether, as a unit, out of proximal jaw 75 and through the tissue. SeeFIGS. 28 and 29 . As this occurs, outer needle 85 closely supports innerneedle 80, and vice-versa, thereby providing increased column strengthfor the two needles and permitting the two relatively thin needles topass through tough tissue, e.g., the tough fibrous capsule of the hip.In this respect it should be appreciated that this mutual needle support(for increased column strength) is a very important aspect of thepresent invention, since it enables the two relatively thin needles topass through extremely tough tissue (e.g., the fibrous capsule of thehip), tissue which neither needle could easily pass through alone, orwhich a single needle might pass through alone but not accurately alongthe desired axis of travel (e.g., the single needle might diverge from astraight path and miss a target zone on the other side of the tissue).

In addition to the foregoing, it should also be appreciated that,significantly, proximal jaw 75 also supports inner needle 80 and outerneedle 85 during their passage through tissue, since only short lengthsof inner needle 80 and outer needle 85 extend beyond (i.e., out of)proximal jaw 75. Again, this needle-reinforcing construction helpsenable the two relatively thin needles to pass through extremely toughtissue (e.g., the fibrous capsule of the hip) which they might nototherwise be able to penetrate on their own, or which they might nototherwise be able to penetrate accurately on their own.

Inner needle 80 and outer needle 85 continue to move distally as a unituntil the distal tips of inner needle 80 and outer needle 85 exit thefar side of the tissue and the distal tip of inner needle 80 starts toenter distal jaw 15. At or near this point, forward advancement of outerneedle 85 is stopped, and inner needle 80 advances alone. As innerneedle 80 advances, its inclined surface 107 (FIG. 21 ) engages theinclined surface 72 of suture seat 70 and/or suture 25, thereby causingsuture seat 70 and distal jaw spring 55 to be cammed downwardly, andthereby releasing suture 25 from the capture previously provided bysuture seat 70 and distal jaw spring 55 (FIGS. 30-33 ). As this occurs,suture 25 is urged distally within suture slot 30, with intermediatediagonal section 40 of suture slot 30 and distal longitudinal section 45of suture slot 30 accommodating suture 25. Inner needle 80 continues tomove distally until suture slot 110 in inner needle 80 is positionedabove suture 25 (FIGS. 34 and 35 ), whereupon distal jaw spring 55 andsuture seat 70 deliver suture 25 up into suture slot 110 in inner needle80 (FIGS. 34 and 35 ), i.e., under the resilient action of distal jawspring 55. Inner needle 80 is then retracted proximally, carrying suture25 with it, until suture 25 encounters the bevelled tip 100 of outerneedle 85, whereupon suture 25 is locked between the two needles (FIG.36 ). This locking acts to secure the suture 25 to the two needles 80,85 with sufficient force that the suture is not dislodged from the innerneedle 80 and outer needle 85 as the two needles are retractedproximally through the tissue and/or as the suture passer 5 is movedfrom the suturing site (e.g., as the suture passer 5 is removed from thepatient).

Then inner needle 80 and outer needle 85 are retracted proximally, as aunit, drawing suture 25 through the tissue which is clamped betweendistal jaw 15 and proximal jaw 75. See FIG. 37 .

Once suture 25 has been passed through the tissue which is clampedbetween distal jaw 15 and proximal jaw 75, proximal jaw 75 is retracted,thereby releasing the tissue (which has suture 25 passing therethrough)from the suture passer. See FIG. 38 .

This passed suture may then be used in ways well known in the art, e.g.,so as to stitch closed a laid-open fibrous capsule.

In one preferred form of the invention, and looking now at FIGS. 39 and40 , shaft 10, distal jaw 15, handle 20 and proximal jaw 75 are formedas one assembly (e.g., such as the tool assembly 130 shown in FIGS. 39and 40 ), and inner needle 80 and outer needle 85 are formed as anotherassembly (e.g., such as the needle assembly 135 shown in FIGS. 39 and 40). Such a construction can be highly advantageous, since it permits toolassembly 130 to be reusable and needle assembly 135 to be disposable.

In one preferred form of the invention, and looking now at FIGS. 41-44 ,needle assembly 135 comprises (i) the aforementioned outer needle 85 anda hub 140 secured to the proximal end of outer needle 85, and (ii) theaforementioned inner needle 80 and a tab 145 secured to the proximal endof inner needle 80. A spring 150 is disposed between hub 140 and tab145, so as to yieldably bias hub 140 and tab 145 away from one another.As a result, spring 150 yieldably biases inner needle 80 proximallyrelative to outer needle 85, as will hereinafter be discussed in furtherdetail.

Looking next at FIGS. 45-48 , handle 20 preferably has a needle carriage155 movably mounted therein. Needle carriage 155 includes a tab slot 160for receiving tab 145 of needle assembly 135, as will hereinafter bediscussed. Trigger 125 is connected to needle carriage 155 so thatmoving trigger 125 towards grip 120 causes needle carriage 155 to movedistally relative to handle 20. Preferably trigger 125 is connected toneedle carriage 155 via a pin-and-slot mechanism, i.e., a pin 165 ridingin a slot 170. A spring 175 (FIG. 47 ), engaging a pin 180 extending outof needle carriage 155, biases needle carriage 155 proximally relativeto handle 20 (and hence biases trigger 125 away from grip 120). Spring175 ensures that needle carriage 155 is returned to the full proximalposition when trigger 125 is released.

Handle 20 also includes a flange seat 185 (FIG. 45 ) movably mountedtherein. Flange seat 185 is spring-mounted to needle carriage 155 sothat flange seat 185 is spring-biased distally from needle carriage 155.In one preferred form of the invention, flange seat 185 isspring-mounted to needle carriage 155 via a pair of posts 190 (FIG. 47 )and a pair of springs 195. Flange seat 185 is adapted to receive alocating flange 200 (FIG. 44 ) on hub 140 as will hereinafter bediscussed.

Handle 20 also includes a proximal jaw carriage 205 (FIG. 46 ) movablymounted therein. Proximal jaw carriage 205 is connected to the proximalend of proximal jaw 75 so that the two elements move as a unit. Anextension 210 of a spring 215 is seated in an opening 220 formed inproximal jaw carriage 205 so that spring 215 biases proximal jawcarriage 205 proximally, and hence biases proximal jaw 75 proximally, aswill hereinafter be discussed.

Needle assembly 135 is loaded into tool assembly 130 by fitting locatingflange 200 (FIG. 44 ) of hub 140 into flange seat 185, and by fittingtab 145 into tab slot 160 of needle carriage 155. See FIG. 48 . Tab 145may preferably be made of a polymer. Tab 145 may have one or more “crushribs” formed on its outer surfaces which help to create a secureinterference fit between tab 145 and tab slot 160; this interference fitaids in preventing needle assembly 135 from inadvertently becomingdislodged from the tool assembly 130 during use (e.g., such as bygravity if the suture passer 5 is used upside down). See, for example,FIG. 46A, which shows a plurality of crush ribs 221 formed on tab 145.These crush ribs 221 form an interference fit with the surrounding wallsof tab slot 160 so as to help hold tab 145 in tab slot 160. Note alsothat in the construction shown in FIG. 46A, tab 145 includes a pair offinger seats 222 to facilitate easy grasping of tab 145 by the user,e.g., when inserting tab 145 into tab slot 160 or when removing tab 145from tab slot 160.

On account of the foregoing construction, when trigger 125 is movedtowards grip 120, proximal jaw carriage 205 is moved distally byextension 210 of spring 215, thereby causing proximal jaw 75 to movedistally so as to engage tissue disposed in the gap 127 between distaljaw 15 and proximal jaw 75. As this occurs, needle carriage 155 alsomoves distally, which in turn causes tab 145 (and hence inner needle 80)to also move distally. At the same time, due to the relative rigidity ofsprings 195 (FIG. 47 ), flange seat 185 also moves distally, causing hub140 (and hence outer needle 85) to also move distally, thereby causinginner needle 80 and outer needle 85 to move distally as a unit.

This coordinated distal movement of proximal jaw 75, inner needle 80 andouter needle 85 continues until the force applied to the tissue byproximal jaw 75 equates to the maximum force that spring 215 (FIG. 46 )can apply. Spring 215 then begins to wind up, whereupon proximal jawcarriage 205 stops moving distally (and hence proximal jaw 75 stopsmoving distally), while needle carriage 155 keeps moving distally,thereby causing inner needle 80 and outer needle 85 to continue movingdistally, whereby to penetrate the tissue in unison.

Continued movement of trigger 125 toward grip 120 causes the elements tomove further distally until flange seat 185 engages a stop 225 formed inhandle 20 (FIG. 49 ), thereby preventing further distal movement offlange seat 185, and hence preventing further distal movement of hub140, and hence preventing further distal movement of outer needle 85.However, continued movement of trigger 125 toward grip 120 causes tab145 to be moved distally (FIG. 50 ) so as to overcome the power ofspring 150 (FIG. 44 ), so that inner needle 80 is advanced distallyrelative to outer needle 85, whereby to permit inner needle 80 to engagesuture seat 70 of distal jaw spring 155, cam distal jaw spring 55 out ofthe way, and align suture slot 110 of inner needle 80 with suture 25.

The amount of relative movement between inner needle 80 and outer needle85 can be set in a variety of ways, including having flange seat 185stop forward distal progress of needle carriage 155. Alternatively,further movement of trigger 125 can be stopped by grip 120 at a setposition so as to limit longitudinal movement of inner needle 80relative to outer needle 85.

Releasing trigger 125 causes, sequentially, needle carriage 155 towithdraw proximally so as to permit inner needle 80 to be movedproximally by spring 150 while hub 140 (and hence outer needle 85)remains stationary, thereby picking up suture 25 in suture slot 110 andthen capturing suture 25 between inner needle 80 and outer needle 85.Continued release of trigger 125 causes tab 145 and hub 140 (and henceinner needle 80 and outer needle 85) to move proximally as a unit, andhence causes inner needle 80 and outer needle 85 to withdraw backthrough the tissue as a unit, carrying the suture therewith. Continuedrelease of trigger 125 causes spring extension 210 to move proximal jawcarriage 205 proximally, whereby to withdraw proximal jaw 75 from thetissue, thereby releasing the tissue from suture passer 5, with suture25 extending through the tissue.

It should be appreciated that the portion of distal jaw spring 55 whichaids in holding suture 25 to distal jaw 15 can take many forms otherthan that shown in FIGS. 24 and 25 . By way of example but notlimitation, the spring surface that comes into contact with the suturecan have a single tooth, multiple teeth or a roughened finish so as topromote the spring's ability to hold the suture. This portion of thedistal jaw spring can also have a perpendicular surface that acts tokeep suture 25 from moving distally as inner needle 80 passes over thesuture.

Thus, FIGS. 50A, 50B and 50C show one alternative form of distal jawspring 55. In this form of the invention, suture seat 70 has itsinclined surface 72 formed with an arcuate configuration to receiveinner needle 80 during its forward stroke, and includes teeth 226 forpositively engaging suture 25 and forcing suture 25 against the opposingside wall of the suture slot. In addition, the proximal end of distaljaw spring 55 is modified so that only one pin 60 (FIG. 19 ) isrequired—this pin 60 acts as a pivot pin, and clockwise motion of distaljaw spring 55 about this pivot pin is limited by a stop surface 227which engages a corresponding stop surface on shaft 10.

FIGS. 50D, 50E and 50F show another alternative form of distal jawspring 55. In this form of the invention, suture seat 70 has a backstopfeature 228 to limit distal migration of suture 25 when inner needle 80is driving past the suture during the needle's forward stroke. In thisembodiment, the beveled tip 100 (FIG. 21 ) of outer needle 85 may act topinch the suture against the backstop feature 228 of distal jaw spring55 so that the suture is securely held in place as the inner needle 80passes over the suture during the needle's forward stroke.

FIGS. 50G and 50H show another alternative form of distal jaw spring 55.In this form of the invention, a suture catch 229 is formed on theproximal side of the suture seat 70. The suture catch 229 limitsproximal migration of suture 25 when, for example, device manipulationresults in forces on the suture 25 which tend to dislodge the suture 25.In this embodiment of the invention, a backstop feature 228 is alsolocated on the distal side of suture seat 70 so as to limit distalmigration of suture 25 when inner needle 80 is driving past the sutureduring the needle's forward stroke. In essence, in this form of theinvention, the suture seat 70 is essentially a trough or recess definedby distal backstop feature 228 and proximal suture catch 229, and suture25 is disposed in this trough or recess, thereby preventing distalmovement of the suture (e.g., due to needle advancement) via distalbackstop feature 228 and preventing proximal movement of the suture(e.g., due to advancement of the needle passer through the septum of acannula) via proximal suture catch 229, whereby to more securely holdsuture 25 to suture passer 5. Preferably the depth of the trough orrecess of suture seat 70 is at least 50% of the height of the suturewhich is to be seated in the trough or recess, so as to reliably retainsuture 25 in the trough or recess of suture seat 70 while distal jawspring 55 is in its spring-biased position (i.e., before distal jawspring 55 is displaced by inner needle 80). In other words, when asuture 25 is seated in the trough or recess of suture seat 70, distalbackstop feature 228 and proximal suture catch 229 will extend up to themidpoint on suture 25 or, preferably, even higher on suture 25, wherebyto provide secure stabilization for the suture vis-à-vis distal jawspring 55. In addition to the foregoing, it should be appreciated thatdistal jaw spring 55 can be made from one or more suitable materialsincluding plastic, metal (e.g., stainless steel, titanium, etc.) and,more specifically, superelastic materials such as Nitinol. Furthermore,the cantilevered portion of distal jaw spring 55 may be one material(e.g., superelastic Nitinol) and the suture-capturing portion of distaljaw spring 55 may be another material (e.g., a molded plastic tip). Inthis respect it should also be appreciated that the cantilevered portionof distal jaw spring 55 may be thicker at its proximal end than at itsdistal end; for example, it may be tapered. Such tapering may allow theflexing characteristics of distal jaw spring 55 to vary along itslength.

FIGS. 51 and 52 show an alternative form of outer needle 85. In thisform of the invention, outer needle 85 includes a suture slot 230 at itsdistal end. Suture slot 230 in outer needle 85 is aligned with, andcooperates with, suture slot 110 in inner needle 80 so as to form apositive suture seat between the two needles when inner needle 80 isretracted toward outer needle 85, whereby to securely capture suture 25to the two needles.

FIGS. 53 and 54 show an alternative form of inner needle 80. In thisform of the invention, inner needle 80 is hollow, so that objects and/orfluids can be passed through the interior of inner needle 80.

FIGS. 55-68 show another preferred construction for the presentinvention. More particularly, the construction shown in FIGS. 55-68 isgenerally similar to the construction shown in FIGS. 16-38 , except that(i) suture slot 30 comprises a proximal diagonal section 235 (FIG. 55 )and a distal substantially vertical section 240, and (ii) suture seat 70in distal jaw spring 55 is replaced by a suture capture block 245 (FIG.56 ). In this form of the invention, suture 25 follows thediagonal/vertical configuration of suture slot 30, and suture captureblock 245 acts to stabilize suture 25 for positive pickup by innerneedle 80.

FIGS. 68A-68N show another preferred construction for the presentinvention. More particularly, the construction shown in FIGS. 68A-68N isgenerally similar to the construction shown in FIGS. 16-38 , with theprimary differences being that: (i) distal jaw spring 55 comprises theconstruction shown in FIGS. 50G and 50H and described above; and (ii)suture slot 30 in distal jaw 55 comprises a proximal longitudinalsection 35 and a distal vertical section 241. Distal jaw spring 55biases suture 25 up into distal vertical section 241 of suture slot 30;this limits migration of suture 25 (i.e., both distally and proximally)when, for example, device manipulation results in forces on the suture25 which tend to dislodge the suture 25 from distal jaw 15. In otherwords, in this form of the invention, distal jaw 15 comprises anL-shaped slot 30 having a distal vertical section 241 and distal jawspring 55 comprises a U-shaped suture seat 70 (i.e., the “trough” sutureseat 70 formed between distal backstop feature 228 and proximal sutureslot catch 229—the two geometries combine with one another so as to forma secure seat for the suture, thereby preventing distal and proximalmovement of the suture. In other words, the two opposing slots (i.e.,distal vertical section 241 of L-shaped slot 30 in distal jaw 15 andtrough suture seat 70 in distal jaw spring 55) combine to capture suture225 therebetween, whereby to prevent any longitudinal migration (i.e.,either distally or proximally) of the suture.

By way of further explanation, FIGS. 68A and 68B show the configurationof the suture passer prior to suture passer being loaded with suture.FIGS. 68C and 68D show the configuration of the suture passer after thesuture passer has been loaded with suture (note that in FIGS. 68C-68N,the suture is omitted from the drawings for clarity of illustration).FIGS. 68E and 68F show initial engagement of inner needle 80 with distaljaw spring 55 during the forward stroke of inner needle 80 and outerneedle 85. FIGS. 68G and 68H show inner needle 80 camming distal jawspring 55 downward during a later stage in the forward stroke of innerneedle 80 and outer needle 85. FIGS. 681 and 68J show the maximum distalextension of inner needle 80 during the forward stroke of inner needle80 and outer needle 85. FIGS. 68K and 68L show inner needle 80retracting proximally from the position shown in FIGS. 681 and 68J.FIGS. 68M and 68N show inner needle 80 and outer needle 85 having movedproximally of distal jaw spring 55, such that distal jaw spring 55 hasreturned to its original position of FIGS. 68A and 68B.

FIGS. 69-84 show another preferred construction of the presentinvention. More particularly, the construction shown in FIGS. 69-84 isgenerally similar to the construction shown in FIGS. 55-68 , except that(i) distal jaw spring 55 and suture capture block 245 are replaced by adistal jaw spring 250 (FIG. 83 ) having a suture guide slot 255 formedtherein, and (ii) outer needle 85 is replaced by the outer needle 85with suture slot 230 shown in FIGS. 51 and 52 . In this form of theinvention, suture 25 is spring-held in suture guide slot 255, andfollows the path of suture slot 30 as distal jaw spring 250 is displacedby inner needle 80.

FIGS. 85-89 show alternative constructions for releasably capturingsuture 25 to distal jaw spring 250.

FIG. 90 shows another preferred construction of the present invention.More particularly, the construction shown in FIG. 90 is generallysimilar to the construction shown in FIGS. 69-84 , except that outerneedle 85 lacks suture slot 230 and may or may not directly engagesuture 25 and may or may not assist in capturing suture 25 to innerneedle 80.

FIGS. 90A, 90B and 90C show another preferred embodiment of the presentinvention. More particularly, in this form of the invention, outerneedle 85 is formed with an inclined tip 256, however, this inclined tipis offset 180 degrees from the inclined surface 107 of inner needle 80,whereby to enhance suture gripping between suture slot 110 of innerneedle 80 and inclined tip 256 of outer needle 85. Furthermore, in thisform of the invention, distal jaw spring 55 is omitted and suture 25 isheld in suture slot 30 of distal jaw 15 by friction.

FIGS. 90D, 90E, 90F, 90G and 901 show a suture passing operation usingthe suture passer of FIGS. 90A, 90B and 90C.

It should also be noted that inner needle 80 can be replaced by a wirewith a loop on the end that can capture the suture (e.g., in the mannerof a suture threader) and pull it into the outer needle. See, forexample, FIGS. 91-94 , where a wire 260, having a hook 265, grapples thesuture and pulls it into outer needle 85.

It should also be noted that inner needle 80 (as shown in FIGS. 21-23 )can function without an outer needle 85. In this embodiment, the innerneedle 80 serves to pick up the suture and carry it proximally withoutthe assistance of the outer needle 85.

FIG. 95 shows another preferred embodiment of the present invention.More particularly, in this form of the invention, thelongitudinally-reciprocating proximal jaw 75 of the suture passer shownin FIGS. 16 and 17 is replaced by a pivoting proximal jaw 270. Moreparticularly, proximal jaw 270 is mounted to elongated shaft 10 via apivot pin 275, such that longitudinal motion of a drive rod 280(connected at its proximal end to proximal jaw carriage 205) causesproximal jaw 270 to pivot about pivot pin 275, whereby to open and closethe jaw relative to distal jaw 15.

Looking next at FIGS. 96 and 97 , there is shown another suture passer 5formed in accordance with the present invention. For purposes ofillustration but not limitation, the suture passer 5 shown in FIGS. 96and 97 is shown to have the distal jaw construction of FIGS. 18 and 19 ,however, other distal jaw constructions may also be utilized. In thisform of the invention, suture passer 5 is constructed so that its distaljaw 15 has an interior passageway 300 extending through the distal jaw.Passageway 300 terminates at its distal end in one or more apertures 305which open on surface 310 of distal jaw 15. Passageway 300 terminates atits proximal end in a vacuum fitting 315 which is disposed on the handle20 of suture passer 5. In this form of the invention, suction (e.g.,from a conventional vacuum source) may be applied to vacuum fitting 315,whereby suction will be established at apertures 305 in surface 310 ofdistal jaw 315, whereby to draw tissue towards apertures 305 and/or tosecure tissue to apertures 305 and thereby facilitate subsequentclamping of the tissue with proximal jaw 75.

Looking next at FIGS. 98-101 , there is shown another suture passer 5also formed in accordance with the present invention. In the suturepasser 5 shown in FIGS. 98-101 , distal jaw 15 comprises two sutureslots 30A, 30B. Suture slot 30A preferably has a configuration similarto that shown in FIGS. 68A-68N. Suture slot 30B preferably has asomewhat different configuration, comprising a vertical slot 320communicating with a horizontal slot 325. In this form of the invention,a loop 325 of suture 25 is passed across suture slot 30B and then backacross suture slot 30A so that two strands of suture 325A, 325B arepresented to inner needle 80 for sequential pickup. To this end, distaljaw spring 55 has a suture seat which is sized to interface with bothsuture strand 325A and suture strand 325B when they are disposed insuture slots 30A, 30B, respectively, whereby to releasably hold suturestrands 325A, 325B to distal jaw 15. Alternatively, distal jaw spring 55could be provided with two separate suture seats, one disposed adjacentsuture slot 30A and one disposed adjacent suture slot 30B, whereby toreleasably hold suture strands 325A, 325B to distal jaw spring 315. Thisform of the invention can be highly useful where suture is to be passedthrough tissue multiple times.

By way of example but not limitation, in one exemplary suture passingoperation, a suture passer 5 carrying a loop 325 of suture 25 ispositioned adjacent the tissue (FIG. 102 ). Next, inner needle 80 ispassed through the tissue so as to pick up the strand 325A of suturepassing through suture slot 30A (FIG. 103 ). Inner needle 80 iswithdrawn back through the tissue, carrying the strand 325A with it(FIG. 104 ). The strand 325A of suture is released from the suturepasser 5, and the suture passer 5 is shifted laterally so it is in alocation where a second strand of suture is to be passed (FIG. 105 ).Preferably the first strand 325A of suture is pulled completely throughthe tissue, e.g., with a separate grasping tool (not shown) (FIG. 106 ).Then inner needle 80 is passed through the tissue so as to pick up thestrand 325B of suture passing through suture slot 30B (FIG. 107 ). Innerneedle 80 is withdrawn back through the tissue, carrying the strand 325Bwith it (FIG. 108 ). The suture passer 5 is withdrawn away from thetissue (FIG. 109 ), and then the strand 325B is released from the suturepasser 5, thereby leaving the loop 325 of suture 25 extending throughthe tissue (FIG. 110 ).

By way of further example but not limitation, in another exemplarysuture passing operation, a suture passer 5 carrying a loop 325 ofsuture 25 is positioned adjacent the tissue (FIG. 111 ). Next, innerneedle 80 is passed through the tissue so as to pick up the strand 325Aof suture passing through suture slot 30A (FIG. 112 ). Inner needle 80is withdrawn back through the tissue, carrying the strand 325A with it(FIG. 113 ). The suture passer 5 is moved away from the tissue (FIG. 114). Preferably the first strand of suture is pulled completely throughthe tissue, e.g., by withdrawing the suture passer 5 (FIG. 114 ). Thenthe strand 325A of suture is released from the suture passer 5, and thesuture passer 5 is advanced back to the tissue and shifted laterally soit is in a location where a second strand of suture is to be passed(FIG. 115 ). Then inner needle 80 is passed through the tissue so as topick up the strand 325B of suture passing through suture slot 30B (FIG.116 ). Inner needle 80 is withdrawn back through the tissue, carryingthe strand 325B with it (FIG. 117 ). The suture passer 5 is withdrawnaway from the tissue (FIG. 118 ), and the suture is released from thesuture passer 5, thereby leaving the loop of suture 325 extendingthrough the tissue (FIG. 119 ).

Use of the Present Invention for Other Applications

It should be appreciated that the present invention may be used toarthoscopically suture the fibrous capsule of the hip joint, so as tofacilitate arthroscopic procedures on the hip joint. The presentinvention can also be used to arthroscopically suture other tissue, bothin the hip joint and in locations other than the hip joint.

Modifications of The Preferred Embodiments

It should be understood that many additional changes in the details,materials, steps and arrangements of parts, which have been hereindescribed and illustrated in order to explain the nature of the presentinvention, may be made by those skilled in the art while still remainingwithin the principles and scope of the invention.

What is claimed is:
 1. A suture passer comprising: a shaft having alongitudinal axis; a first jaw located at a distal end of the shaft andcomprising a slot that faces in a proximal direction for receiving aportion of a suture such that the portion of the suture extendstransversely to the longitudinal axis of the shaft; a second jawtranslatably mounted to the shaft, wherein the second jaw can betranslated toward the first jaw for gripping a portion of tissue betweenthe first and second jaws; and a needle extending at least partiallywithin the second jaw and translatable relative to the second jaw sothat the needle can be advanced toward the distal end of the shaft andcan extend out of the second jaw through the portion of tissue grippedbetween the first and second jaws, the needle comprising a hook forhooking the portion of the suture received in the slot of the first jaw,wherein after hooking the portion of the suture, the needle can pull thesuture out of the slot and free the suture of the first jaw.
 2. Thesuture passer of claim 1, wherein the suture passer is configured topull a loop of suture through an opening in the portion of tissuecreated by the needle.
 3. The suture passer of claim 1, wherein theportion of the suture is a looped portion of the suture.
 4. The suturepasser of claim 1, comprising a handle assembly located at a proximalend of the shaft.
 5. The suture passer of claim 1, wherein the handleassembly is configured to control movement of the second jaw and theneedle.
 6. The suture passer of claim 1, wherein the shaft comprises anopening for receiving the portion of tissue, the opening is open towarda first direction and the handle assembly extends from the shaft in asecond direction that is opposite the first direction.
 7. The suturepasser of claim 1, wherein the shaft comprises a channel that isproximal of the first jaw and at least a portion of the needle isreceived in the channel.
 8. The suture passer of claim 1, wherein thesecond jaw comprises a lumen and at least a portion of the needle isreceived in the lumen.
 9. The suture passer of claim 1, wherein thefirst jaw comprises an aperture, the slot is located proximally of atleast a portion of the aperture, and a distal end of the needle istranslatable through the aperture.
 10. The suture passer of claim 1,wherein the hook is configured to hook the portion of the suture on areturn stroke of the needle.
 11. The suture passer of claim 1, whereinthe slot comprises a horizontally extending proximal section and avertically extending distal section.
 12. The suture passer of claim 1,further comprising a retaining member located in the first jaw forreleasably retaining the portion of the suture on the first jaw.
 13. Thesuture passer of claim 1, wherein the needle is removable from theshaft.
 14. A suture passer comprising: a shaft; a first jaw located at adistal end of the shaft; a second jaw slidably mounted to the shaftproximally of the first jaw; a needle slidably mounted to the shaft; ahandle assembly comprising a first portion and a second portion, whereinthe first portion is configured to move relative to the second portionwhen a user squeezes on the handle assembly and the handle assembly isoperatively connected to the second jaw and needle so that squeezing thefirst and second portions together by a first amount moves the secondjaw toward the first jaw for gripping a portion of tissue between thejaws and squeezing the first and second portions together by a secondamount advances the needle through the portion of tissue gripped betweenthe first and second jaws.
 15. The suture passer of claim 14, whereinsqueezing the first and second portions together by the first amountadvances the needle along with the second jaw.
 16. The suture passer ofclaim 14, wherein the second portion is fixed relative to the shaft. 17.The suture passer of claim 14, wherein the first portion is a trigger.18. The suture passer of claim 17, wherein the trigger is pivotallyconnected to the handle assembly.
 19. The suture passer of claim 14,wherein the first jaw is configured for releasably retaining a portionof a suture.
 20. The suture passer of claim 14, wherein the needle isremovable from the shaft.
 21. A suture passer comprising: a shaft; afirst jaw located at a distal end of the shaft; a second jaw slidablymounted to the shaft proximally of the first jaw; a handle assemblycomprising a first portion and a second portion, wherein the firstportion is configured to move relative to the second portion when a usersqueezes on the handle assembly, the handle assembly is operativelyconnected to the second jaw so that squeezing the first and secondportions together by a first amount moves the second jaw toward thefirst jaw for gripping a portion of tissue between the jaws, and when aneedle is slidably mounted to the shaft, the handle assembly isoperatively connected to the needle so that squeezing the first andsecond portions together by a second amount advances the needle throughthe portion of tissue gripped between the first and second jaws.
 22. Thesuture passer of claim 21, further comprising the needle.